| NPI | 1881656189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 160852) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 2690) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2011-02-28 |