| NPI | 1962138339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024195689) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1094657) |
| 163W00000X Registered Nurse (Licence: TX 841587) | |
| Enumeration Date | 2022-07-28 |
| Last Update Date | 2025-12-18 |