| NPI | 1699722017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN071875) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 42233) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2008-11-26 |