| NPI | 1194463059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1082644) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101699) |
| Enumeration Date | 2022-05-21 |
| Last Update Date | 2024-07-25 |