| NPI | 1508674516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61649011) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IN 153506) |
| Enumeration Date | 2024-12-23 |
| Last Update Date | 2026-01-05 |