| NPI | 1003358722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WY 41753.1789) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 910781) |
| Enumeration Date | 2016-11-11 |
| Last Update Date | 2018-10-29 |