| NPI | 1013211002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MO 2011004548) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2011000121) |
| Enumeration Date | 2011-01-05 |
| Last Update Date | 2026-04-24 |