| NPI | 1679510895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-040392) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 536442) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2019-03-21 |