| NPI | 1548600745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 6631838-4406) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 261722) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: ID RNA-932A) | |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2021-11-15 |