| NPI | 1386142594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP136236) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 27802) |
| Enumeration Date | 2018-01-23 |
| Last Update Date | 2024-05-07 |