| NPI | 1730557133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 7202773-4406) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA1163) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 7202773-8901) | |
| Enumeration Date | 2015-09-02 |
| Last Update Date | 2020-06-23 |