| NPI | 1215463351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 13191732-8901) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2023-03-07 |