| NPI | 1922421718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP125050) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 848585) |
| Enumeration Date | 2014-01-29 |
| Last Update Date | 2019-10-22 |