| NPI | 1972651859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1088997) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AL 1-088997) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2008-02-11 |