| NPI | 1124085600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R 139446-9) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209006983) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2014-07-29 |