| NPI | 1528502135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 130781) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 110875) |
| Enumeration Date | 2016-12-15 |
| Last Update Date | 2019-11-18 |