| NPI | 1033805023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95002057) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D185086) |
| Enumeration Date | 2023-04-13 |
| Last Update Date | 2025-07-02 |