| NPI | 1104281328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 6619546-4406) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 6619546-3102) |
| Enumeration Date | 2015-12-15 |
| Last Update Date | 2022-11-17 |