| NPI | 1578133963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024187424) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: DC RN1062381) |
| Enumeration Date | 2021-06-28 |
| Last Update Date | 2025-12-19 |