| NPI | 1487631610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 222218) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 667146) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2009-02-10 |