| NPI | 1982842654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 738896) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO APN.0090767-CRNA) |
| Enumeration Date | 2009-02-03 |
| Last Update Date | 2025-11-19 |