| NPI | 1083853972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS A810420) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 641918) |
| Enumeration Date | 2009-02-17 |
| Last Update Date | 2015-07-23 |