| NPI | 1659534113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP124704) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS R868392) |
| Enumeration Date | 2008-07-05 |
| Last Update Date | 2015-03-05 |