| NPI | 1013201508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP134085) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 15999) |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2024-08-02 |