| NPI | 1053861062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP132137) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 112331) |
| Enumeration Date | 2016-10-13 |
| Last Update Date | 2018-08-22 |