| NPI | 1538637863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 6062) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 264172) |
| Enumeration Date | 2018-11-05 |
| Last Update Date | 2026-05-26 |