| NPI | 1104900802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 126644) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 126644) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 048816) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 3550) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2025-08-19 |