| NPI | 1104255769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP124918) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 846305) |
| Enumeration Date | 2013-11-04 |
| Last Update Date | 2022-07-21 |