| NPI | 1710662598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1150823) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 891874) |
| Enumeration Date | 2023-06-19 |
| Last Update Date | 2024-02-20 |