| NPI | 1891393674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1031586) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 860601) |
| Enumeration Date | 2020-10-13 |
| Last Update Date | 2022-11-22 |