| NPI | 1306583299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 35493) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 235348) |
| Enumeration Date | 2022-05-12 |
| Last Update Date | 2024-02-06 |