| NPI | 1336505031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP145291) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 112179) |
| Enumeration Date | 2016-01-11 |
| Last Update Date | 2021-06-28 |