| NPI | 1235675505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP133225) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 194087) |
| Enumeration Date | 2017-01-11 |
| Last Update Date | 2023-11-08 |