| NPI | 1376884163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 105641) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 761346) |
| Enumeration Date | 2013-03-05 |
| Last Update Date | 2017-10-17 |