| NPI | 1942658828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 202113244CRNA) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 2298367) |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2025-12-02 |