| NPI | 1164726295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP120230) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 683871) |
| Enumeration Date | 2011-01-04 |
| Last Update Date | 2022-10-07 |