| NPI | 1811945926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP110601) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 613247) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2017-12-05 |