| NPI | 1205534369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN742685) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 0021146) |
| 163W00000X Registered Nurse (Licence: PA RN742685) | |
| Enumeration Date | 2023-02-20 |
| Last Update Date | 2025-05-02 |