| NPI | 1881107597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX 827040) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11017617) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP136354) | |
| Enumeration Date | 2017-11-16 |
| Last Update Date | 2023-06-20 |