| NPI | 1558478651 |
|---|---|
| Doing Business As | |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 56593-030) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 330-033) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2007-07-08 |