| NPI | 1083671986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 175201) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 541986) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2007-10-04 |