| NPI | 1376012195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-135849) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-135849) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 36169) | |
| Enumeration Date | 2018-11-21 |
| Last Update Date | 2025-08-20 |