| NPI | 1780752451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-080299) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN159563) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2009-08-17 |