| NPI | 1033831508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN323918) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 124739) |
| Enumeration Date | 2022-09-13 |
| Last Update Date | 2025-04-18 |