| NPI | 1225739477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 231769) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 253383-30) |
| 163W00000X Registered Nurse (Licence: LA RN147858) | |
| Enumeration Date | 2023-03-14 |
| Last Update Date | 2023-10-17 |