| NPI | 1902200421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP126267) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 753022) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 753022) | |
| Enumeration Date | 2014-10-13 |
| Last Update Date | 2021-11-30 |