| NPI | 1043382682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 129863) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 3349) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2023-04-13 |