| NPI | 1780980300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP119851) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 736430) |
| Enumeration Date | 2011-01-28 |
| Last Update Date | 2025-03-04 |