| NPI | 1942671946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP141653) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 110287) |
| Enumeration Date | 2015-10-15 |
| Last Update Date | 2020-09-23 |