| NPI | 1801127980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AK 166193) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0024174762) |
| Enumeration Date | 2010-01-29 |
| Last Update Date | 2026-03-05 |