| NPI | 1174214639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1139698) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101755) |
| Enumeration Date | 2023-05-16 |
| Last Update Date | 2025-02-24 |