| NPI | 1851961122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1064922) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 1064922) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 6779) | |
| Enumeration Date | 2021-06-29 |
| Last Update Date | 2024-03-12 |