| NPI | 1629585153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2026015192) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 931712) |
| Enumeration Date | 2018-01-05 |
| Last Update Date | 2026-06-30 |