| NPI | 1942379920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000107) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: HI APRN-870) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2025-07-07 |