| NPI | 1891426946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1089458) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS 901780) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 31827) | |
| Enumeration Date | 2022-06-20 |
| Last Update Date | 2024-03-28 |