| NPI | 1609314400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS 901422) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 4045094) |
| Enumeration Date | 2017-02-01 |
| Last Update Date | 2025-09-17 |