| NPI | 1174411813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR 155597) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R104292) |
| Enumeration Date | 2025-06-24 |
| Last Update Date | 2025-08-22 |