| NPI | 1538537766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP129831) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704281131) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704281131) | |
| 163W00000X Registered Nurse (Licence: TX 890094) | |
| Enumeration Date | 2015-09-03 |
| Last Update Date | 2016-07-21 |