| NPI | 1639342108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP116919) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 753695) |
| Enumeration Date | 2008-04-07 |
| Last Update Date | 2020-06-25 |