| NPI | 1629349725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP130716) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 773968) |
| Enumeration Date | 2012-01-20 |
| Last Update Date | 2021-12-28 |