| NPI | 1710254594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP121342) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 717390) |
| Enumeration Date | 2011-11-22 |
| Last Update Date | 2022-08-11 |