| NPI | 1699752824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP102999) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 530834) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2020-06-17 |