| NPI | 1669823167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP131387) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 796603) |
| 163W00000X Registered Nurse (Licence: MA 2286035) | |
| Enumeration Date | 2016-06-26 |
| Last Update Date | 2022-09-13 |