| NPI | 1255080578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NV 810359) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV 810359) |
| Enumeration Date | 2022-03-23 |
| Last Update Date | 2022-10-18 |