| NPI | 1790313294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 9796529-4406) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: UT 9796529-3102) |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2023-08-25 |