| NPI | 1710654074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1068499) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 133873) |
| Enumeration Date | 2021-08-25 |
| Last Update Date | 2022-07-22 |