| NPI | 1376793398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 4033-33) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D140467) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209007110) | |
| Enumeration Date | 2008-09-26 |
| Last Update Date | 2023-09-13 |