| NPI | 1316598147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP144705) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 850286) |
| Enumeration Date | 2019-09-23 |
| Last Update Date | 2020-01-27 |