| NPI | 1144999798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 35461) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 220161) |
| Enumeration Date | 2021-09-08 |
| Last Update Date | 2024-02-22 |