| NPI | 1114280120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP121977) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 816705) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2020-10-12 |