| NPI | 1194109785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP130333) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 802851) |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2021-11-18 |