| NPI | 1114694163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN788324) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 333042) |
| Enumeration Date | 2021-08-26 |
| Last Update Date | 2025-01-07 |