| NPI | 1861522690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 004498) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: DC RN47286) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2011-02-02 |