| NPI | 1528807005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 8236) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: LA 149189) |
| Enumeration Date | 2024-05-23 |
| Last Update Date | 2026-08-12 |