| NPI | 1396312641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 862329) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 27437) |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2023-07-05 |