| NPI | 1043202740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 37573) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: SC 3021) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 55549) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 3021) | |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2016-04-28 |