| NPI | 1205291325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP129945) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 771324) |
| Enumeration Date | 2015-12-16 |
| Last Update Date | 2019-11-21 |