| NPI | 1124065651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX AP115816) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN042686 AP02297) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN217364) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2019-06-25 |