| NPI | 1194342857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1011381) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 872445) |
| 163W00000X Registered Nurse (Licence: CA 95159598) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 62642) | |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2021-12-02 |