| NPI | 1003468190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1130963) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 647231) |
| Enumeration Date | 2019-07-10 |
| Last Update Date | 2024-03-13 |