| NPI | 1326815135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1180657) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: LA 211335) |
| Enumeration Date | 2023-12-11 |
| Last Update Date | 2025-02-12 |