| NPI | 1871550533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 352) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC R32177) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2011-03-25 |