| NPI | 1124116272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 610463) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 610463) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2011-09-28 |