| NPI | 1477592525 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP113714)  | 
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 672594)  | 
| Enumeration Date | 2006-06-05 | 
| Last Update Date | 2024-03-27 |