| NPI | 1174292445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA 136268) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN258274) |
| Enumeration Date | 2021-09-09 |
| Last Update Date | 2023-03-06 |