| NPI | 1043673999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP132751) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA STU020282) |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2020-05-19 |