| NPI | 1104878834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 54591) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 104886) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2007-07-09 |