| NPI | 1649717091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 100088) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 826001) |
| Enumeration Date | 2017-01-24 |
| Last Update Date | 2017-01-24 |