| NPI | 1588458640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 10045955) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201807567RN) |
| Enumeration Date | 2025-04-05 |
| Last Update Date | 2025-06-25 |