| NPI | 1699196576 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP124916) | 
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 806849) | 
| Enumeration Date | 2013-12-19 | 
| Last Update Date | 2020-04-28 |