| NPI | 1467021949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1050427) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 972309) |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2022-03-30 |