| NPI | 1588034961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024193259) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 259899) |
| Enumeration Date | 2015-09-29 |
| Last Update Date | 2025-05-07 |