| NPI | 1831686922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP137769) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 121878) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 830196) | |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2019-07-10 |