| NPI | 1982149076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 130511) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 813003) |
| Enumeration Date | 2016-12-27 |
| Last Update Date | 2021-03-11 |