| NPI | 1962471896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 549574) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN569547) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 036849) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2017-01-23 |