| NPI | 1427558543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP140802) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 239270) |
| Enumeration Date | 2018-02-15 |
| Last Update Date | 2025-07-21 |