| NPI | 1497475024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1141719) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 139107) |
| Enumeration Date | 2022-09-01 |
| Last Update Date | 2024-05-07 |