| NPI | 1487096434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 93089) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9317826) |
| 163W00000X Registered Nurse (Licence: MN 215610-1) | |
| Enumeration Date | 2013-07-18 |
| Last Update Date | 2015-12-10 |