| NPI | 1003806464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 642422) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX 642422) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2016-08-05 |