| NPI | 1285465500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 148555) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX 1168232) |
| Enumeration Date | 2024-08-08 |
| Last Update Date | 2026-06-17 |