| NPI | 1174671911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR CTP000030) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 76370) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2011-04-05 |