| NPI | 1114297256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 723401) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA 87895) |
| Enumeration Date | 2012-01-06 |
| Last Update Date | 2021-05-25 |