| NPI | 1669944757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP142791) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 123783) |
| Enumeration Date | 2018-12-30 |
| Last Update Date | 2023-10-12 |