| NPI | 1558656918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA RN113308) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 139606) |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2011-07-18 |