| NPI | 1144042656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101910) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ID 56157) |
| Enumeration Date | 2024-10-26 |
| Last Update Date | 2025-04-08 |