| NPI | 1023101383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 084548) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209-001689) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704131876) | |
| Enumeration Date | 2006-10-01 |
| Last Update Date | 2008-10-20 |