| NPI | 1689724502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 3103) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 137348) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2007-07-08 |