| NPI | 1487637138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP108412) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C01190) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 568172) | |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2022-01-25 |