| NPI | 1245911262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 4012118) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL rn9356204) |
| Enumeration Date | 2023-07-31 |
| Last Update Date | 2024-01-25 |