| NPI | 1861908113 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 818199) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 818199) |
| 163W00000X Registered Nurse (Licence: FL RN9394356) | |
| Enumeration Date | 2017-12-22 |
| Last Update Date | 2018-04-29 |