| NPI | 1831510494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 126280) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 15494-NA) |
| Enumeration Date | 2013-12-30 |
| Last Update Date | 2023-11-08 |