| NPI | 1598594913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 153623) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R237780) |
| Enumeration Date | 2024-08-01 |
| Last Update Date | 2025-08-19 |