| NPI | 1972603751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ RN094667) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 054009-21) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2007-07-09 |