| NPI | 1174085013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP140387) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 891970) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2023-04-24 |