| NPI | 1275379075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95002424) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MT NUR-APRN-LIC-264144) |
| Enumeration Date | 2024-07-02 |
| Last Update Date | 2025-11-16 |