| NPI | 1932403458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95002748) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 686775) |
| Enumeration Date | 2010-12-23 |
| Last Update Date | 2026-01-05 |