| NPI | 1174886196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN593822) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 146061) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2016-09-14 |