| NPI | 1497148258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1131000) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WY 35077.1384) |
| Enumeration Date | 2015-03-17 |
| Last Update Date | 2023-09-29 |