| NPI | 1790294932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP135297) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 742600) |
| Enumeration Date | 2017-09-20 |
| Last Update Date | 2020-08-18 |