| NPI | 1255322459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209009504) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IN 28162626A) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP114460) | |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2018-03-17 |