| NPI | 1083246631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 12656056-8901) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP145077) |
| Enumeration Date | 2020-02-11 |
| Last Update Date | 2022-10-10 |