| NPI | 1790871663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP114537) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 613630) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2022-10-04 |