| 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 |