| NPI | 1124064258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 660218) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 72566) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2009-08-14 |