| NPI | 1942244744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP112805) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN10298) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP1627092) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2020-09-12 |