| NPI | 1063401149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM R41329) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 695165) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2009-07-06 |