| NPI | 1366858169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1101538) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 7801) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 102393) | |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2025-08-07 |