| NPI | 1134633605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP136883) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 938209) |
| Enumeration Date | 2017-11-20 |
| Last Update Date | 2022-06-24 |