| NPI | 1619713617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 150043) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR 215092) |
| Enumeration Date | 2024-07-08 |
| Last Update Date | 2026-08-07 |