| NPI | 1639620941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 22265) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001237944) |
| Enumeration Date | 2016-10-21 |
| Last Update Date | 2025-09-18 |