| NPI | 1891768271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 3947) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM R50620) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2014-05-14 |