| NPI | 1477524049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP111070) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 678383) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2022-09-21 |