| NPI | 1093243784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WY 49813) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 917614) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP134983) | |
| Enumeration Date | 2017-05-25 |
| Last Update Date | 2024-08-07 |