| NPI | 1508919382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP121677) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 158021) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2020-06-19 |