| NPI | 1184123499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP136631) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 929860) |
| Enumeration Date | 2018-02-02 |
| Last Update Date | 2022-01-28 |