| NPI | 1043973605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1126212) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 892739) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 31226) | |
| Enumeration Date | 2021-10-20 |
| Last Update Date | 2024-01-04 |