| NPI | 1619382371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP125829) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 771625) |
| Enumeration Date | 2014-06-21 |
| Last Update Date | 2023-08-18 |