| NPI | 1669049219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1044861) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 133679) |
| Enumeration Date | 2021-06-10 |
| Last Update Date | 2021-08-13 |