| NPI | 1386183663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP134285) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 770163) |
| Enumeration Date | 2017-02-19 |
| Last Update Date | 2017-07-18 |