| NPI | 1467828533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 24862) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 710989) |
| Enumeration Date | 2015-08-12 |
| Last Update Date | 2025-01-17 |