| NPI | 1699864066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP104155) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX 545412) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 545412) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2022-06-04 |