| NPI | 1407486012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 8764516-8901) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 8764516-3102) |
| Enumeration Date | 2020-01-22 |
| Last Update Date | 2020-07-09 |