| NPI | 1851690424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP136123) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 4029) |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2018-03-17 |