| NPI | 1104547306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1096037) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 138871) |
| Enumeration Date | 2022-09-06 |
| Last Update Date | 2023-05-19 |