| NPI | 1043591290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 16094) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 975012) |
| Enumeration Date | 2011-09-01 |
| Last Update Date | 2026-03-27 |