| NPI | 1760926513 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP134105) | 
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 4045095) | 
| Enumeration Date | 2016-12-13 | 
| Last Update Date | 2025-10-03 |