| NPI | 1205802865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP110694) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 541070) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2020-06-10 |