| NPI | 1235161027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 047961) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 526665) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NM CRNA00638) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2024-05-28 |