| NPI | 1134664295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 786035) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 130052) |
| Enumeration Date | 2016-12-28 |
| Last Update Date | 2021-11-10 |