| NPI | 1225450661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C003013) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR CTP-000261) |
| 163W00000X Registered Nurse (Licence: AR R082848) | |
| Enumeration Date | 2014-01-18 |
| Last Update Date | 2026-05-18 |