| NPI | 1063402634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 202002199CRNA) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 691160) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2020-07-31 |