| NPI | 1174794127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 5252922-4406) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ID N37726) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: ID RNA-717) | |
| Enumeration Date | 2008-03-18 |
| Last Update Date | 2022-10-19 |