| NPI | 1770520967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD AC000362) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 71474) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2010-04-12 |