| NPI | 1588650642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP111146) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 612271) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2020-09-16 |