| NPI | 1811599210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 6839) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 749616) |
| Enumeration Date | 2020-11-10 |
| Last Update Date | 2026-01-30 |