| NPI | 1255077301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 137560) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001268324) |
| Enumeration Date | 2022-05-11 |
| Last Update Date | 2022-05-13 |