| NPI | 1073532586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704102356) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 639435) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 64025-030) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2007-07-08 |