| NPI | 1093672057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024197715) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001274278) |
| Enumeration Date | 2026-01-09 |
| Last Update Date | 2026-06-10 |