| NPI | 1003187600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP121393) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 143857) |
| Enumeration Date | 2012-01-13 |
| Last Update Date | 2018-06-05 |