| NPI | 1366259848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1190230) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 878291) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 152624) | |
| Enumeration Date | 2024-12-17 |
| Last Update Date | 2025-02-12 |