| NPI | 1205378098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP133544) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN664861) |
| 282N00000X General Acute Care Hospital (Licence: TX 912946) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 116076) | |
| Enumeration Date | 2016-11-09 |
| Last Update Date | 2020-07-06 |