| NPI | 1558692780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 113333) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 776338) |
| Enumeration Date | 2010-01-28 |
| Last Update Date | 2025-06-06 |