| NPI | 1790103109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP125140) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 130764) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2015-10-27 |