| NPI | 1720182710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 5130028-4406) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM CRNA-01505) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2021-10-26 |