| NPI | 1124698212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1067939) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9437736) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11017232) | |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2024-04-26 |