| NPI | 1538535380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 877689) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2022035160) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 27704) | |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2023-12-01 |