| NPI | 1730115411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 04168) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA 089996) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 706014) | |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2016-10-12 |