| NPI | 1780060491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61025134) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 782574) |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2022-01-14 |