| NPI | 1508857988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA RN00092141) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 747513) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2009-03-17 |