| NPI | 1629685821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1031243) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 9798891-3102) |
| Enumeration Date | 2020-09-30 |
| Last Update Date | 2021-07-06 |