| NPI | 1831661107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP140711) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 706575) |
| Enumeration Date | 2018-12-26 |
| Last Update Date | 2019-10-18 |