| NPI | 1790002830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NM CRNA-01074) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 01074) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP121846) | |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2024-02-01 |