| NPI | 1285345660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209.026960) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2017025334) |
| Enumeration Date | 2022-12-07 |
| Last Update Date | 2023-04-24 |