| NPI | 1760264766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1172014) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL RN9551689) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11031602) | |
| Enumeration Date | 2023-10-16 |
| Last Update Date | 2024-09-10 |