| NPI | 1396847943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 644786) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 073193) |
| Enumeration Date | 2006-09-03 |
| Last Update Date | 2010-06-18 |