| NPI | 1124026240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: SC 70835) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 2926) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 162214) | |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2025-11-03 |