| NPI | 1861486565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID RNA-357) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: ID N24684) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP30004499) | |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2010-07-13 |