| NPI | 1578666905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP109460) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 513084) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 42814) | |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2020-10-14 |