| NPI | 1063180834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1111721) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN254509) |
| Enumeration Date | 2021-09-05 |
| Last Update Date | 2023-06-20 |