| NPI | 1184058802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 679239) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 201901670CRNA) |
| Enumeration Date | 2013-08-29 |
| Last Update Date | 2023-03-14 |