| NPI | 1255865127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 7033) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 275751) |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2025-11-03 |