| NPI | 1790376721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 9423152-4406) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 9423152-3102) |
| Enumeration Date | 2021-02-02 |
| Last Update Date | 2021-03-22 |