| NPI | 1043637838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 758719) |
| Additional Taxonomies | 163WP0000X Registered Nurse, Pain Management (Licence: TX 102120) |
| Enumeration Date | 2014-03-18 |
| Last Update Date | 2024-10-24 |