| NPI | 1104844257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP104324) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 580487) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2020-07-15 |