| NPI | 1538614599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP133475) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041410226) |
| Enumeration Date | 2016-08-19 |
| Last Update Date | 2019-05-21 |