| NPI | 1023774700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 304095) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9439764) |
| Enumeration Date | 2021-11-16 |
| Last Update Date | 2024-03-14 |