| NPI | 1326535097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D150807) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MT NUR-APRN-LIC-177651) |
| Enumeration Date | 2018-04-18 |
| Last Update Date | 2025-04-20 |