| NPI | 1083246011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1105571) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11038358) |
| 163W00000X Registered Nurse (Licence: FL RN9377446) | |
| 163W00000X Registered Nurse (Licence: TX 1105571) | |
| Enumeration Date | 2020-02-07 |
| Last Update Date | 2025-05-06 |