| NPI | 1801467816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1098816) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95050591) |
| Enumeration Date | 2021-07-09 |
| Last Update Date | 2024-01-10 |