| NPI | 1154078558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 876592) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R216305) |
| Enumeration Date | 2022-03-05 |
| Last Update Date | 2023-03-17 |