| NPI | 1124008560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP118498) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP 9178159) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024127218) | |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2017-04-19 |