| NPI | 1730141862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP100989) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 248975) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2022-01-24 |