| NPI | 1285636803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 111469) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR CO1214) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 55052) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OK R0073155) | |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2008-05-20 |