| NPI | 1154614642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP119995) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 725248) |
| Enumeration Date | 2011-05-17 |
| Last Update Date | 2022-10-25 |