| NPI | 1396049672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 912215) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 1396049672) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-12-31 |
| Last Update Date | 2017-03-30 |