| NPI | 1104129543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 728665) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 728665) |
| Enumeration Date | 2010-12-07 |
| Last Update Date | 2024-01-10 |