| NPI | 1417436015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP140329) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 766821) |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2021-04-12 |