| NPI | 1710028345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP116710) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NV Pending) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2023-09-12 |