| NPI | 1669030789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP143320) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 297829) |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2020-03-17 |