| NPI | 1053650671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 852982) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA ap07170) |
| Enumeration Date | 2013-02-01 |
| Last Update Date | 2014-08-06 |