| NPI | 1265717904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 786298) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 786298) |
| Enumeration Date | 2011-10-13 |
| Last Update Date | 2014-05-21 |