| NPI | 1164640926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2004031200) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D-102109) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2007-07-08 |