| NPI | 1083043483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209011709) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA 60828812) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000074) | |
| Enumeration Date | 2013-11-06 |
| Last Update Date | 2018-05-29 |