| NPI | 1639750573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP1202089) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 458368) |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2025-08-28 |