| NPI | 1326658808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1047864) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 6640) |
| Enumeration Date | 2020-08-09 |
| Last Update Date | 2022-07-16 |