| NPI | 1780769992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 18726) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK R0058406) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2014-07-24 |