| NPI | 1699335331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 9161774) |
| Additional Taxonomies | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: OR 10023628) |
| 163W00000X Registered Nurse (Licence: AZ RN170524) | |
| Enumeration Date | 2019-06-14 |
| Last Update Date | 2026-02-11 |