| NPI | 1598388365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1010458) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R40320) |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2021-01-19 |