| NPI | 1760746473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: IN 722221) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R200861) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 722221) | |
| 367H00000X Anesthesiologist Assistant (Licence: TX 722221) | |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2023-03-14 |