| NPI | 1073711891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP123969) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 12794) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3007916) | |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2022-08-18 |