| NPI | 1457365702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP110859) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1052457) |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2018-04-26 |