| NPI | 1972799864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP117479) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 677555) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 182818) | |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2021-12-07 |