| NPI | 1316243850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 75560) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 85310) |
| Enumeration Date | 2011-02-01 |
| Last Update Date | 2015-08-13 |