| NPI | 1023388378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000333) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 808011) |
| Enumeration Date | 2012-01-04 |
| Last Update Date | 2021-02-24 |