| NPI | 1619198363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP129728) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN054618) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP02498) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2024-08-23 |