| NPI | 1366051005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024180046) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 296000) |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2025-09-07 |