| NPI | 1790179042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP128347) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 765094) |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2021-06-28 |