| NPI | 1225209240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX ap123128) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 094793) |
| Enumeration Date | 2008-03-18 |
| Last Update Date | 2016-05-22 |