| NPI | 1871132167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP144822) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 127846) |
| Enumeration Date | 2020-01-03 |
| Last Update Date | 2023-07-05 |