| NPI | 1164352514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 8266) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 157737) |
| Enumeration Date | 2026-05-19 |
| Last Update Date | 2026-07-15 |