| NPI | 1609146877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 230878) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 798766) |
| Enumeration Date | 2012-01-05 |
| Last Update Date | 2016-09-15 |