| NPI | 1134605199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 848542) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 6260) |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2026-06-15 |