| NPI | 1396156592 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP125808) | 
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 768942) | 
| Enumeration Date | 2014-05-12 | 
| Last Update Date | 2023-03-30 |