| NPI | 1649570615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 736869) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 736869) |
| 163W00000X Registered Nurse (Licence: LA 121651) | |
| Enumeration Date | 2010-10-25 |
| Last Update Date | 2015-03-05 |