| NPI | 1689600017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP114782) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 675709) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209030064) | |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2024-09-24 |