| NPI | 1477561959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP119844) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 089007561CRNA) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209019914) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2019-10-28 |