| NPI | 1962910083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP136218) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 802953) |
| Enumeration Date | 2018-01-11 |
| Last Update Date | 2019-05-14 |