| NPI | 1114264801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP136733) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C002942) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209010158) | |
| Enumeration Date | 2013-01-15 |
| Last Update Date | 2021-04-07 |