| NPI | 1134208747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA RN060064 AP03067) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX 704395) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 704395) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2009-01-17 |