| NPI | 1649202722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP104339) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 043435) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2021-06-25 |