| NPI | 1750876934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1082538) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 12.007633) |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2022-09-28 |