| NPI | 1962491365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN281109) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 274955) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2015-04-15 |