| NPI | 1467939355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 362798) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 118642) |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2025-12-11 |