| NPI | 1982242228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA95002428) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN712350) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1033724) | |
| Enumeration Date | 2019-12-17 |
| Last Update Date | 2025-10-15 |