| NPI | 1629348768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA95001290) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 725199) |
| Enumeration Date | 2012-01-06 |
| Last Update Date | 2020-04-09 |