| NPI | 1740674894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024184236) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 668015) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NM CRNA-01467) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP128885) | |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2024-05-23 |