| NPI | 1215019302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME119831) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KS 6792) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 54682) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2014-09-02 |