| NPI | 1063250876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TN 266707) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 753543) |
| Enumeration Date | 2024-07-16 |
| Last Update Date | 2025-12-22 |