| NPI | 1578540704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP113649) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 662426) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2022-11-11 |