| NPI | 1376514893 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA0431) | 
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 200060018crna) | 
| Enumeration Date | 2006-02-01 | 
| Last Update Date | 2025-05-08 |