| NPI | 1609969583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 105291) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 1492144101) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2007-07-08 |