| NPI | 1154492767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 54172) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 087070) |
| 163W00000X Registered Nurse (Licence: NY 678430) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2015-03-16 |