| NPI | 1770805533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP118701) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 642015) |
| Enumeration Date | 2010-02-22 |
| Last Update Date | 2017-03-21 |