| NPI | 1194370486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP143064) |
| Additional Taxonomies | 286500000X Military Hospital |
| Enumeration Date | 2019-08-05 |
| Last Update Date | 2022-08-26 |