| NPI | 1376788042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 331810) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28180788A) |
| Enumeration Date | 2008-12-10 |
| Last Update Date | 2026-04-28 |