| NPI | 1487522801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2376070) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95165685) |
| 163W00000X Registered Nurse (Licence: NM RN-77213) | |
| Enumeration Date | 2025-10-27 |
| Last Update Date | 2026-07-06 |