| NPI | 1194349266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95002518) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 129182) |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2026-04-13 |