| NPI | 1699420018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1082383) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL RN9345660) |
| Enumeration Date | 2022-02-14 |
| Last Update Date | 2022-06-07 |