| NPI | 1669989877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA1469) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN183911) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 74785) | |
| Enumeration Date | 2018-01-09 |
| Last Update Date | 2025-08-14 |