| NPI | 1255636916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP119817) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 708712) |
| Enumeration Date | 2011-01-11 |
| Last Update Date | 2023-02-21 |