| NPI | 1609347962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1070648) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 75999) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101528) | |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2023-07-25 |