| NPI | 1801471990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1034619) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9553558) |
| Enumeration Date | 2021-03-10 |
| Last Update Date | 2023-03-16 |