| NPI | 1801219720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP125069) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 829384) |
| Enumeration Date | 2014-01-29 |
| Last Update Date | 2021-12-08 |