| NPI | 1386144525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 28155) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 280128) |
| Enumeration Date | 2018-02-14 |
| Last Update Date | 2025-04-17 |