| NPI | 1912621467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 138289) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: TX 888067) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: HI 80853) | |
| Enumeration Date | 2022-09-28 |
| Last Update Date | 2022-10-07 |