| NPI | 1548304025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 264714-4406) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID RNA-677) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2009-06-30 |