| NPI | 1609998376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP115735) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 076818) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2022-10-19 |