| NPI | 1922378421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2012019347) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC R204149) |
| Enumeration Date | 2011-12-31 |
| Last Update Date | 2025-10-16 |