| NPI | 1689309593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024195691) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 850145) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D185371) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1096015) | |
| Enumeration Date | 2022-07-24 |
| Last Update Date | 2026-03-20 |