| NPI | 1255493953 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 4359) | 
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 158511) | 
| Enumeration Date | 2006-12-16 | 
| Last Update Date | 2023-05-24 |