| NPI | 1356886832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 8380193-3102) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ TEMP329019) |
| Enumeration Date | 2016-12-20 |
| Last Update Date | 2025-09-19 |