| NPI | 1144166752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 8268) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 364712) |
| Enumeration Date | 2026-04-27 |
| Last Update Date | 2026-06-26 |