| NPI | 1285274357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 130096) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D185084) |
| Enumeration Date | 2020-01-07 |
| Last Update Date | 2025-07-07 |