| NPI | 1831636513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP133334) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 909574) |
| 163W00000X Registered Nurse (Licence: LA 122687) | |
| Enumeration Date | 2017-01-19 |
| Last Update Date | 2020-09-23 |