| NPI | 1013535616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA AP61076820) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 973706) |
| Enumeration Date | 2020-07-09 |
| Last Update Date | 2025-04-09 |