| NPI | 1679568976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 578697) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 578697) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2025-11-10 |