| NPI | 1568802791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 839913) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 102785) |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2014-03-20 |