| NPI | 1194727115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 050018) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 050018) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2022-12-16 |