| NPI | 1710722798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 007561) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 74459) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101864) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024191342) | |
| Enumeration Date | 2024-07-01 |
| Last Update Date | 2026-02-26 |