| NPI | 1285317065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1136518) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R101983) |
| Enumeration Date | 2023-08-09 |
| Last Update Date | 2023-09-27 |