| NPI | 1972105815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 899643) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: LA 203830) |
| Enumeration Date | 2020-11-16 |
| Last Update Date | 2025-07-10 |