| NPI | 1689063968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP127266) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 103208) |
| Enumeration Date | 2015-01-09 |
| Last Update Date | 2022-07-26 |