| NPI | 1043643679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 54198) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 101281) |
| Enumeration Date | 2013-08-19 |
| Last Update Date | 2018-11-27 |