| NPI | 1114222007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP120094) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX 086758) |
| Enumeration Date | 2011-01-24 |
| Last Update Date | 2025-05-27 |