| NPI | 1679576755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 000010225) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 4047) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 637070) | |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2019-01-03 |