| NPI | 1144900234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 79307) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 876610) |
| Enumeration Date | 2023-07-24 |
| Last Update Date | 2025-08-27 |