| NPI | 1063862142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP131172) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 744040) |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2020-04-27 |