| NPI | 1235783317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 9034821-4406) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ 9034821-3102) |
| Enumeration Date | 2019-07-28 |
| Last Update Date | 2023-02-06 |