| NPI | 1689309593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1096015) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D185371) |
| Enumeration Date | 2022-07-24 |
| Last Update Date | 2025-09-18 |