| NPI | 1235886888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024186357) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: VA 0001293209) |
| Enumeration Date | 2022-03-03 |
| Last Update Date | 2024-02-07 |