| NPI | 1225576945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP133952) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 791356) |
| Enumeration Date | 2017-02-01 |
| Last Update Date | 2020-07-29 |