| 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 |