| NPI | 1134367600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP120634) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN 159090) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN 14177) | |
| Enumeration Date | 2009-01-21 |
| Last Update Date | 2020-07-21 |