| NPI | 1760494694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 201407790crna) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 176907) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 053057-23-11) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2016-05-11 |