| NPI | 1134358229 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024168386) | 
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 4031743) | 
| Enumeration Date | 2009-07-09 | 
| Last Update Date | 2025-01-15 |