| NPI | 1265847065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 141150) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 741032) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MT 195491) | |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2026-06-05 |