| NPI | 1669153201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1206752) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11039751) |
| 163W00000X Registered Nurse (Licence: FL RN9463804) | |
| Enumeration Date | 2023-07-27 |
| Last Update Date | 2025-07-17 |