| NPI | 1942360425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP112903) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 595708) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2021-05-20 |