| NPI | 1952971053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024183359) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 136642) |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2026-10-01 |