| NPI | 1699750703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP02716) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: LA 35000) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: LA RN035000) | |
| Enumeration Date | 2005-12-12 |
| Last Update Date | 2008-08-18 |