| NPI | 1255876348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP132890) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 853309) |
| 163W00000X Registered Nurse (Licence: LA RN139391) | |
| Enumeration Date | 2016-12-27 |
| Last Update Date | 2021-04-30 |