| NPI | 1972525228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 3912) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 050569) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2016-11-09 |