| NPI | 1891860169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN169732) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 50304) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2011-04-05 |