| NPI | 1508854084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP134976) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 66768) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CO CRA-2470) | |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2020-08-17 |