| NPI | 1487280632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1086711) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 879459) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 137897) | |
| Enumeration Date | 2020-03-19 |
| Last Update Date | 2023-01-20 |