| NPI | 1467818211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP129949) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 764416) |
| Enumeration Date | 2016-01-10 |
| Last Update Date | 2023-10-02 |