| NPI | 1760733554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1135471) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 640297) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 640297-1) | |
| Enumeration Date | 2012-09-20 |
| Last Update Date | 2023-11-07 |