| NPI | 1023517281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN203070) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 877644) |
| Enumeration Date | 2018-02-02 |
| Last Update Date | 2021-07-16 |