| NPI | 1013575844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP143683) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 275012) |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2019-11-19 |