| NPI | 1699756049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 651740) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA03406) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2009-05-04 |