| NPI | 1477158269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 314601) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 9654723-8901) |
| Enumeration Date | 2020-12-01 |
| Last Update Date | 2025-08-27 |