| NPI | 1689673162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP113789) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 19817A) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2022-07-08 |