| 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 |