| NPI | 1992229140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: WV 34345) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 34345) |
| Enumeration Date | 2017-07-31 |
| Last Update Date | 2025-11-12 |