| NPI | 1952817371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2025046995) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 672864) |
| Enumeration Date | 2017-12-20 |
| Last Update Date | 2025-11-24 |