| NPI | 1679036107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1072408) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 723802) |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2023-05-10 |