| NPI | 1134871601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP1068871) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 136031) |
| Enumeration Date | 2022-01-25 |
| Last Update Date | 2022-02-17 |