| NPI | 1710466560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1192815) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: TX 1192815) |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2025-07-17 |