| NPI | 1285096891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024173683) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 0123456789) |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2025-12-22 |