| NPI | 1205938891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 107510) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 45558) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2016-06-06 |