| NPI | 1639560055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP128139) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX AP128139) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557317) | |
| Enumeration Date | 2015-02-06 |
| Last Update Date | 2022-10-11 |