| NPI | 1326532102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 006673) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 118652) |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2025-03-25 |