| NPI | 1063987600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 200198) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 898076) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP140507) | |
| Enumeration Date | 2018-10-10 |
| Last Update Date | 2022-04-29 |