| NPI | 1104936996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 233573) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM R20232) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2008-01-29 |