| NPI | 1942774344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1008204) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 007038) |
| Enumeration Date | 2019-01-18 |
| Last Update Date | 2025-08-01 |