| NPI | 1164482055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP114401) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 721332) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2021-11-01 |