| NPI | 1386015311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS 901360) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP129256) |
| Enumeration Date | 2015-10-16 |
| Last Update Date | 2017-02-06 |