| NPI | 1770093650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO APN.0998420-CRNA) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 5061101-8901) |
| Enumeration Date | 2017-10-05 |
| Last Update Date | 2026-05-30 |