| NPI | 1972561934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 5363) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN177821) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2016-02-08 |