| NPI | 1609120948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000290) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 728009) |
| Enumeration Date | 2012-11-08 |
| Last Update Date | 2022-08-24 |