| NPI | 1396721684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 102375) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 54662) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2007-07-08 |