| NPI | 1497642730 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR 124649) | 
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: AR 124649) | 
| Enumeration Date | 2025-06-19 | 
| Last Update Date | 2025-08-06 |