| NPI | 1144861626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 873088) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 639739) |
| Enumeration Date | 2019-10-04 |
| Last Update Date | 2025-08-28 |