| NPI | 1114247558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP121700) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 698962) |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2021-06-09 |