| NPI | 1285261057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 131243) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN702922) |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2025-08-12 |