| NPI | 1023042686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA 101116) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 55485) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2019-05-28 |