| NPI | 1902552896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 138789) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 874699) |
| Enumeration Date | 2022-03-01 |
| Last Update Date | 2022-09-06 |