| NPI | 1023104585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704248601) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 87753) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2009-01-14 |