| NPI | 1548820723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 141874) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 848512) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2022-06-04 |