| NPI | 1942246657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 5014) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 2912) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2013-12-23 |