| NPI | 1316917420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 0087300) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 648163) |
| 163W00000X Registered Nurse (Licence: OK 0087300) | |
| 163W00000X Registered Nurse (Licence: TX 648163) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2017-12-18 |