| 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 |