| NPI | 1508553876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1129158) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11030744) |
| 163W00000X Registered Nurse (Licence: FL 9358445) | |
| 163W00000X Registered Nurse (Licence: FL RN9358445) | |
| Enumeration Date | 2023-04-18 |
| Last Update Date | 2024-01-30 |