| NPI | 1700841749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA3391) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS R852460) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2012-03-14 |