| NPI | 1639442148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 980042) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 089542) |
| Enumeration Date | 2012-02-14 |
| Last Update Date | 2025-05-06 |