| NPI | 1053396416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 102713) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2002000772) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 55040) | |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2012-01-10 |