| NPI | 1285368985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 7674) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 24184638) |
| Enumeration Date | 2022-07-11 |
| Last Update Date | 2025-04-15 |