| NPI | 1770641201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024166305) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 654610) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2010-08-24 |