| NPI | 1245917111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024189396) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001285505) |
| Enumeration Date | 2023-06-30 |
| Last Update Date | 2024-02-19 |