| NPI | 1174708192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP116686) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 634513) |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2020-09-23 |