| NPI | 1609265867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP127188) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 700749) |
| Enumeration Date | 2015-01-12 |
| Last Update Date | 2016-08-08 |