| NPI | 1134389885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP116930) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 698353) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 78740) | |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2025-04-08 |