| NPI | 1306516794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1150844) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 251418) |
| Enumeration Date | 2021-09-16 |
| Last Update Date | 2024-03-13 |