| NPI | 1659355121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 09.006191) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 1484659051) |
| 163W00000X Registered Nurse (Licence: MO 134677) | |
| 363L00000X Nurse Practitioner (Licence: KS 54725) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 54725) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 134677) | |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2010-05-21 |