| NPI | 1003570953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 31025) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 182595) |
| Enumeration Date | 2021-10-27 |
| Last Update Date | 2022-03-17 |