| NPI | 1225149057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 683221) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM R56078) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2015-04-28 |