| NPI | 1205458296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP146132) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 841002) |
| Enumeration Date | 2020-05-12 |
| Last Update Date | 2020-10-01 |