| NPI | 1942241138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D083428) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 268) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2008-11-24 |