| NPI | 1811622392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1095999) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 227281) |
| Enumeration Date | 2022-07-19 |
| Last Update Date | 2023-10-03 |