| NPI | 1598045338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 725539) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R46798) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 725539) | |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2018-10-15 |