| NPI | 1235896804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 303784) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: AZ RN195362) |
| Enumeration Date | 2021-11-18 |
| Last Update Date | 2025-11-14 |