| NPI | 1184929812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP119862) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 792258) |
| Enumeration Date | 2011-01-11 |
| Last Update Date | 2020-06-09 |