| NPI | 1891513602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1177020) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 968914) |
| Enumeration Date | 2024-09-30 |
| Last Update Date | 2024-11-21 |