| NPI | 1861012510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024179424) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 31906) |
| Enumeration Date | 2020-04-23 |
| Last Update Date | 2026-04-29 |