| NPI | 1285714949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX N7780) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: LA 200978) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 200978) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2013-04-11 |