| NPI | 1700089869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: DE L60A00266) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN313314L) |
| 367H00000X Anesthesiologist Assistant (Licence: DE L60A00266) | |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2009-12-11 |