| NPI | 1588048029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP129988) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 785156) |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2020-06-29 |