| NPI | 1912796087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 14879) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 143468) |
| Enumeration Date | 2025-05-05 |
| Last Update Date | 2025-06-10 |