| NPI | 1346211737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NC 168656) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C01382) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 168656) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024165747) | |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2025-09-11 |