| NPI | 1972490621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR 234821) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9539691) |
| Enumeration Date | 2025-06-23 |
| Last Update Date | 2025-11-25 |