| NPI | 1477910206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024195690) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ID 65427) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP 9422825) | |
| Enumeration Date | 2016-01-25 |
| Last Update Date | 2026-01-20 |