| NPI | 1225847668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 153129) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WV 104810) |
| Enumeration Date | 2024-12-31 |
| Last Update Date | 2025-01-13 |