| NPI | 1205905742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 308861-4406) |
| Additional Taxonomies | 364SM0705X Clinical Nurse Specialist, Medical-Surgical (Licence: UT 308861-4405) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2013-02-19 |