| NPI | 1801625421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MT 267591) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN286537) |
| Enumeration Date | 2024-07-31 |
| Last Update Date | 2025-09-22 |