| NPI | 1538181003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: LA RN104066-AP05228) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 726194) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2016-10-12 |