| NPI | 1225785744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024186496) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001267539) |
| Enumeration Date | 2022-03-04 |
| Last Update Date | 2023-03-21 |