| NPI | 1003571001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 37944) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 215232) |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2025-01-22 |