| NPI | 1265516140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024172861) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 051433) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2026-04-28 |