| NPI | 1982146288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 201801356CRNA) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024174471) |
| 163W00000X Registered Nurse (Licence: VA 0001244563) | |
| Enumeration Date | 2016-11-17 |
| Last Update Date | 2025-10-06 |