| NPI | 1417934431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 619214) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IN 619214) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2023-10-20 |