| NPI | 1518004860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 075858) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: CA 655560) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2020-07-15 |