| NPI | 1154620235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 703507) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 4032) |
| Enumeration Date | 2011-03-15 |
| Last Update Date | 2018-02-19 |