| NPI | 1740472281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 075840) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 125736) |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2009-04-06 |