| NPI | 1902614258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1187893) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 931264) |
| Enumeration Date | 2024-12-19 |
| Last Update Date | 2025-01-17 |