| NPI | 1619633294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1080252) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PR 93240) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11019294) | |
| Enumeration Date | 2021-11-09 |
| Last Update Date | 2022-09-25 |