| NPI | 1023591286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001848) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 756374) |
| Enumeration Date | 2018-09-12 |
| Last Update Date | 2025-03-17 |