| NPI | 1972591220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO CRA-196) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 55688) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2011-11-03 |