| NPI | 1003520750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 10054799) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 10054799) |
| Enumeration Date | 2023-01-09 |
| Last Update Date | 2026-04-29 |