| NPI | 1639391436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP115685) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 667362) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2021-01-12 |