| NPI | 1619197548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1020056) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM CRNA-01302) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2021-08-24 |