| NPI | 1578855722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP128943) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 12229-NA) |
| Enumeration Date | 2011-05-06 |
| Last Update Date | 2025-06-27 |