| NPI | 1902044746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP117758) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 649632) |
| Enumeration Date | 2009-02-02 |
| Last Update Date | 2024-07-22 |