| NPI | 1114325669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP127317) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R088021) |
| Enumeration Date | 2014-12-16 |
| Last Update Date | 2023-01-05 |