| NPI | 1831387810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000146) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024167412) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CO SRA-25003) | |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2016-08-25 |