| NPI | 1912595281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 295738) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 006345) |
| Enumeration Date | 2021-01-04 |
| Last Update Date | 2025-09-19 |