| NPI | 1952633448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000142) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 276242) |
| Enumeration Date | 2010-02-08 |
| Last Update Date | 2015-01-09 |