| NPI | 1639642812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP141660) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11032247) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 124595) | |
| Enumeration Date | 2019-01-09 |
| Last Update Date | 2024-04-28 |