| NPI | 1205108719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 912991) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024169815) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-558274-062) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2024047434) | |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2025-08-06 |