| NPI | 1225754997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024187559) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK 205822) |
| Enumeration Date | 2022-10-14 |
| Last Update Date | 2026-01-07 |