| NPI | 1891075594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 18675) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 647053) |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2025-01-20 |