| NPI | 1912950478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 074751) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 55397) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2007-07-09 |