| NPI | 1104179456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2012019338) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43557111102) |
| Enumeration Date | 2012-10-24 |
| Last Update Date | 2012-11-08 |