| NPI | 1679949499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1027652) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 646863) |
| Enumeration Date | 2015-08-16 |
| Last Update Date | 2021-07-13 |