| NPI | 1588074553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP125764) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 749885) |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2023-10-18 |