| NPI | 1558319657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP106076) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 454854) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2020-07-01 |