| NPI | 1558618991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP122214) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 768724) |
| Enumeration Date | 2012-08-03 |
| Last Update Date | 2023-11-21 |