| NPI | 1245213370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 19952) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 51590) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 585321) | |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2015-06-30 |