| NPI | 1013489764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP140878) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 124582) |
| Enumeration Date | 2018-12-19 |
| Last Update Date | 2024-01-17 |