| NPI | 1891934790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA0759) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: AZ AP10632) |
| Enumeration Date | 2009-02-17 |
| Last Update Date | 2025-07-30 |