| NPI | 1730130444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 616942) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 499237) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2010-03-30 |