| NPI | 1043392640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA0483) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ RN143767) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 681332) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2007-11-08 |