| NPI | 1770980559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 868710) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 127820) |
| Enumeration Date | 2014-11-22 |
| Last Update Date | 2015-01-20 |