| NPI | 1639210081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP115481) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN068052) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP03241) | |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2019-09-30 |