| NPI | 1366228108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1135459) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN158645) |
| Enumeration Date | 2023-09-07 |
| Last Update Date | 2023-12-18 |