| NPI | 1700992542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-022882) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209-003553) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 2314A) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 059367) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2010-02-16 |