| NPI | 1972503340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 931) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC APN931) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2016-12-21 |