| NPI | 1366931651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001557) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 836991) |
| Enumeration Date | 2018-05-02 |
| Last Update Date | 2022-07-28 |