| NPI | 1861344517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2026030298) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2005024451) |
| Enumeration Date | 2026-02-13 |
| Last Update Date | 2026-06-30 |