| NPI | 1750684619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 60890) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP119747) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 783147) | |
| Enumeration Date | 2010-12-15 |
| Last Update Date | 2020-09-11 |