| NPI | 1639121411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP114545) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 670862) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2018-06-11 |