| NPI | 1740794205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 70178714406) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN669787) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 70178718901) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 57261) | |
| Enumeration Date | 2017-11-20 |
| Last Update Date | 2023-08-23 |