| NPI | 1770932584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP131561) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 112160) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2020-05-21 |