| NPI | 1063070142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP141899) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 816658) |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2022-07-25 |