| NPI | 1750300182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 530245) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID N-29165) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2020-07-02 |