| NPI | 1205425485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024192163) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1025846) |
| Enumeration Date | 2021-01-13 |
| Last Update Date | 2025-08-25 |