| NPI | 1184172090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000644) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 754906) |
| Enumeration Date | 2016-09-20 |
| Last Update Date | 2025-10-09 |