| NPI | 1609082635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP112443) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 048275) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2020-08-03 |