| NPI | 1972829976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101165) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD SD-RN) |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2014-10-13 |