| NPI | 1023794088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11037108) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PR 145271) |
| Enumeration Date | 2023-06-26 |
| Last Update Date | 2025-01-31 |