| NPI | 1073248951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MO 2019031860) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D175009) |
| Enumeration Date | 2022-07-23 |
| Last Update Date | 2023-07-25 |