| NPI | 1255094587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 223402) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1054626) |
| Enumeration Date | 2021-10-13 |
| Last Update Date | 2025-06-05 |