| NPI | 1740742667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 6179728-4406) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NV 819572) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2021-10-25 |