| NPI | 1255668661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 200483) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 083704) |
| Enumeration Date | 2009-11-05 |
| Last Update Date | 2021-04-16 |