| NPI | 1639537764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1030468) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS 901379) |
| Enumeration Date | 2016-02-03 |
| Last Update Date | 2021-11-04 |