| NPI | 1649787326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001417) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 117527) |
| Enumeration Date | 2018-01-04 |
| Last Update Date | 2026-08-31 |