| NPI | 1043575640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP121925) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 743080) |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2020-06-30 |