| NPI | 1669245692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1140870) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D185013) |
| Enumeration Date | 2023-11-01 |
| Last Update Date | 2025-07-09 |