| NPI | 1003188699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 814527) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 120081) |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2012-05-08 |