| NPI | 1134317456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP116518) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 668047) |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2020-07-01 |