| NPI | 1013383009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP128833) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND 203844) |
| Enumeration Date | 2015-08-13 |
| Last Update Date | 2025-12-23 |