| NPI | 1174107890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61178973) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 922912) |
| Enumeration Date | 2021-05-09 |
| Last Update Date | 2025-08-08 |