| NPI | 1487924692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP129787) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 184380-30) |
| Enumeration Date | 2012-01-04 |
| Last Update Date | 2025-12-01 |