| NPI | 1710947023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP101777) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX 453169) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2016-10-31 |