| NPI | 1780684068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP103431) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 566340) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2020-05-14 |