| NPI | 1245214485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024172145) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC R87119) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2026-02-17 |