| NPI | 1063547495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP103776) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 61878) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2018-07-13 |