| NPI | 1497782965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 3569) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 148253) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 045884) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2023-06-07 |