| NPI | 1699745703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP111606) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 605142) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 2734) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2024-01-03 |