| NPI | 1902889314 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP110938) | 
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 52604) | 
| Enumeration Date | 2005-11-21 | 
| Last Update Date | 2020-06-29 |