| NPI | 1235956780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2025027009) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13-151663-091) |
| Enumeration Date | 2024-09-25 |
| Last Update Date | 2026-04-24 |