| NPI | 1013211861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP119816) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 722442) |
| Enumeration Date | 2011-01-07 |
| Last Update Date | 2020-06-08 |