| NPI | 1891050761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 60252) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 775096) |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2023-11-01 |