| NPI | 1497702856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 660801) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 10115) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2022-02-17 |