| NPI | 1285203646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 205565) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK R0110938) |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2022-01-28 |