| NPI | 1669239711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 117411-23) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001317054) |
| Enumeration Date | 2024-03-05 |
| Last Update Date | 2026-06-17 |