| NPI | 1972598415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS R861446) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ME AA113017) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2011-06-28 |