| NPI | 1306845508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP102926) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM CRNA00801) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 04035) | |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2022-12-16 |