| NPI | 1013690288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1138854) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R108058) |
| Enumeration Date | 2023-08-14 |
| Last Update Date | 2023-10-17 |