| NPI | 1609267129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1003541) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 19605) |
| Enumeration Date | 2015-02-06 |
| Last Update Date | 2020-10-12 |