| NPI | 1306021282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP121182) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: LA RN085277) |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2022-12-29 |