| NPI | 1235800517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO APN.0997223-CRNA) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 3-002924) |
| 163W00000X Registered Nurse (Licence: NC 313305) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 1660435) | |
| Enumeration Date | 2021-09-25 |
| Last Update Date | 2026-03-31 |