| NPI | 1063986537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP140217) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 10006822) |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2025-03-11 |