| NPI | 1811454580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP140859) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 824099) |
| Enumeration Date | 2019-02-28 |
| Last Update Date | 2020-08-06 |