| NPI | 1144300468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 04436) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 835046) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2016-10-13 |