| NPI | 1861471518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R176827) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 244446) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 49407) | |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2010-05-03 |