| NPI | 1285636191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP131818) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NV CRNA000292) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2019-12-19 |