| NPI | 1912516170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1026882) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 891645) |
| Enumeration Date | 2020-07-23 |
| Last Update Date | 2021-04-08 |