| NPI | 1821531666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 321815) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2009020842) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2017000665) | |
| Enumeration Date | 2016-11-28 |
| Last Update Date | 2025-08-26 |