| NPI | 1508881707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 360493-4406) |
| Additional Taxonomies | 174400000X Specialist (Licence: ID RNA659) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2024-04-29 |