| NPI | 1760752695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 744782) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 98827) |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2020-07-22 |