| NPI | 1114902459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP125348) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN507103L) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61122412) | |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2022-02-23 |