| NPI | 1912593724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1031410) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 821582) |
| Enumeration Date | 2020-12-15 |
| Last Update Date | 2021-04-16 |