| NPI | 1619707759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GU 100723) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK R0102612) |
| Enumeration Date | 2024-08-05 |
| Last Update Date | 2026-07-07 |