| NPI | 1205131653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN564516) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R189735) |
| Enumeration Date | 2011-01-17 |
| Last Update Date | 2025-10-06 |