| 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 |