| NPI | 1992944896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 356745) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 13976) |
| Enumeration Date | 2009-02-17 |
| Last Update Date | 2020-01-16 |