| NPI | 1184910796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP120324) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 799214) |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2022-01-25 |