| NPI | 1679092936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 8026309-3102) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: UT 8026309-4406) |
| Enumeration Date | 2017-09-18 |
| Last Update Date | 2021-11-03 |