| NPI | 1790148328 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP130007) | 
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 114912-23) | 
| Enumeration Date | 2016-03-31 | 
| Last Update Date | 2025-06-23 |