| NPI | 1063711828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 656163) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS 876819) |
| Enumeration Date | 2011-03-19 |
| Last Update Date | 2011-08-11 |