| NPI | 1487166963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1065465) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ RN157814) |
| Enumeration Date | 2017-10-24 |
| Last Update Date | 2023-02-20 |