| NPI | 1124554340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP135129) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 635921) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11011475) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 919662) | |
| Enumeration Date | 2017-05-08 |
| Last Update Date | 2021-09-29 |