| NPI | 1780359653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH JORDAN WHITING Owner 512-201-9957 |
| Organization Subpart ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered |
| Enumeration Date | 2021-08-12 |
| Last Update Date | 2021-08-12 |