| NPI | 1861464232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 673986) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 7152) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2023-08-23 |