| NPI | 1700509056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 10350673-8901) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 10350673-3102) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 10350673-4406) | |
| Enumeration Date | 2022-09-21 |
| Last Update Date | 2022-12-24 |