| NPI | 1891196945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 58551) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 166152) |
| Enumeration Date | 2014-09-09 |
| Last Update Date | 2022-03-01 |