| NPI | 1285905950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP121513) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 184951-30) |
| Enumeration Date | 2012-01-26 |
| Last Update Date | 2018-06-01 |