| NPI | 1275074403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP134418) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN143859) |
| 163W00000X Registered Nurse (Licence: TX 786780) | |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2020-02-05 |