| NPI | 1104617620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 14873) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 134632) |
| Enumeration Date | 2025-05-14 |
| Last Update Date | 2025-09-04 |