| NPI | 1477830339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 6579518-4406) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 087962) |
| Enumeration Date | 2011-11-07 |
| Last Update Date | 2021-10-25 |