| NPI | 1376131631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN650008) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 137382) |
| Enumeration Date | 2021-01-04 |
| Last Update Date | 2026-06-05 |