| NPI | 1215411061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP141164) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: TX 841393) |
| Enumeration Date | 2018-09-18 |
| Last Update Date | 2019-08-02 |