| NPI | 1821149923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP141381) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NV CRNA000147) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2020-11-02 |