| NPI | 1871530121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D066113) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 367500000x) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2009-06-15 |