| NPI | 1255326971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD R022644) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R 125243-3) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D-092532) | |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2008-12-12 |