| NPI | 1245809060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-172132) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA GAA-CRNA004003) |
| 163W00000X Registered Nurse (Licence: AL 1-172132) | |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2025-12-14 |