| NPI | 1902207640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX ap127200) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 750853) |
| Enumeration Date | 2014-09-12 |
| Last Update Date | 2015-01-07 |