| NPI | 1245241538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS R856328) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA GAA-CRNA004109) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2026-07-14 |