| NPI | 1689203556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1086308) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11019847) |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2022-07-01 |