| NPI | 1538726351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 100982875) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 836923) |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2023-09-15 |