| NPI | 1710975933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM CRNA00561) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 656484) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2025-01-17 |