| NPI | 1144675943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP08637) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 128482) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP130328) | |
| Enumeration Date | 2016-04-29 |
| Last Update Date | 2016-10-03 |