| NPI | 1770640245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704128661) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4704128661) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2011-05-31 |