| NPI | 1548374150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA RN069794 AP03244) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 619487) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2010-07-29 |