| NPI | 1710557210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 136110) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 9693) |
| Enumeration Date | 2021-06-28 |
| Last Update Date | 2026-05-05 |