| NPI | 1639809213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 115100-23) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60831976) |
| Enumeration Date | 2022-06-15 |
| Last Update Date | 2025-07-11 |