| NPI | 1639917529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ TEMP327534) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 230485) |
| Enumeration Date | 2024-07-16 |
| Last Update Date | 2025-08-22 |