| NPI | 1093690695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 336433) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9615104) |
| 163W00000X Registered Nurse (Licence: NY 798456) | |
| Enumeration Date | 2025-08-11 |
| Last Update Date | 2026-03-04 |