| NPI | 1366150336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 10637895-4406) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9546186) |
| Enumeration Date | 2022-11-09 |
| Last Update Date | 2024-08-22 |