| NPI | 1306455589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1029373) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.462751) |
| 163W00000X Registered Nurse (Licence: TX 874771) | |
| Enumeration Date | 2020-07-23 |
| Last Update Date | 2021-02-05 |