| NPI | 1619963667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 243531) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C01278) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 038631) | |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2009-03-03 |