| NPI | 1063494722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA RN036422 APO2191) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 031963) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9285473) | |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2012-08-08 |