| NPI | 1740370642 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP109776) | 
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 557932) | 
| Enumeration Date | 2006-10-13 | 
| Last Update Date | 2022-06-21 |