| NPI | 1528360500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA RN267568) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 795614) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP120577) | |
| Enumeration Date | 2010-11-24 |
| Last Update Date | 2024-12-17 |