| NPI | 1679682579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 1873) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 87828) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2025-01-24 |