| NPI | 1740287580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: DE L60A00528) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R133458) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NR12969700) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2007-07-08 |