| NPI | 1346877834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP145711) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2011008339) |
| 163W00000X Registered Nurse (Licence: KS 13-114322-121) | |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2020-03-27 |