| NPI | 1861290967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 16700-33) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 232540-30) |
| Enumeration Date | 2025-03-04 |
| Last Update Date | 2025-04-12 |