| NPI | 1699648964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 31050) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC 31050) |
| Enumeration Date | 2025-09-24 |
| Last Update Date | 2025-10-21 |