| NPI | 1871922666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 1925) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA0993) |
| 163W00000X Registered Nurse (Licence: SD R037114) | |
| Enumeration Date | 2013-11-02 |
| Last Update Date | 2026-06-22 |