| NPI | 1750704664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 92556) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 65550) |
| Enumeration Date | 2014-01-28 |
| Last Update Date | 2023-07-21 |