| NPI | 1245892827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61450763) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX Interim) |
| Enumeration Date | 2019-07-03 |
| Last Update Date | 2025-07-18 |